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Welcome to Ultimate Health Plans. Below, please find frequently referenced plan documents.


Evidence of Coverage

The Evidence of Coverage booklet tells you how to get your Medicare medical care and prescription drugs covered through our plan. This booklet explains your rights and responsibilities, what is covered, and what you pay as a member of the plan. Chapter 4 of the EOC focuses on your covered services and what you pay for your medical benefits. It includes a Medical Benefits Chart that lists your covered services and shows how much you will pay for each covered service as a member of Ultimate Health Plans. It also has information about medical services that are not covered and explains limits on certain services.

The PDF documents can be downloaded and then viewed with Adobe Reader.

 

Annual Notice of Change

 

Summary of Benefits

The Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of our benefits, please access the “Evidence of Coverage” document above.


Over The Counter (OTC) Medicines and Supplies

 

To order OTC products online, click here.

Quality Program

Ultimate Health Plans maintains a Quality Program to improve quality of care and member health outcomes. The Quality Program provides the framework for how we monitor the quality of care and services that our members receive. Through this program, we develop clinical initiatives and process improvements. On an annual basis, Ultimate Health Plans measures the program's effectiveness.


Quality Monitoring

Ultimate Health Plans analyzes many different types of data, including member clinical data (such as claims, lab results, and diagnoses) as well as member and provider appeals and grievances. Ultimate also monitors its internal processes.

Ultimate Health Plans annually measures the quality of care and services its members receive through the use of HEDIS® measures (Healthcare Effectiveness Data and Information Set). Ultimate Health Plans also conducts annual member surveys to determine what members think about the health plan, their physicians, and their own health. This survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We also look at member responses to the Medicare Health Outcomes Survey (HOS), which tells us how its members feel about their health.

Ultimate Health Plans also monitors measures of patient safety on an annual basis. Ultimate maintains programs to improve patient safety, such as through medication reconciliation and the use of high-risk medications.


Quality Monitoring

Ultimate Health Plans uses the Quality Program to implement ongoing, continuous quality improvement projects and interventions. Examples of quality projects may include:

  • Flu shot clinics
  • Reminder calls to members when they are due for specific care, such as a mammogram or colonoscopy
  • Member incentive programs
  • Provider education

Measuring and Reporting Quality

One of the ways that you can determine how well we are doing is by looking at our Medicare Star Rating. Every year, Medicare evaluates plans based on a 5-star rating system. This system is based on the health plan’s quality and performance. You can find information about our current star rating at

Ultimate Health Plans is evaluated by the National Committee for Quality Assurance (NCQA) every three years. You can review our report card here: https://reportcards.ncqa.org/#/health-plan/Hp_3_1_001G000001uwtBdIAI

Ultimate Health Plans also establishes internal goals and benchmarks in an annual quality work plan. Quality monitoring information is reported to the Quality Management Steering Committee. This committee reports to the Ultimate Health Plans Board of Directors.

For more information about this program, please contact Member Services at 1-888-657-4170 (TTY: 711).

 

This page was last modified: 3/16/2021 3:23:38 PM
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Ultimate Health Plans is an HMO plan with a Medicare contract. Enrollment in Ultimate Health Plans depends on contract renewal. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Ultimate Health Plans does not collect any member information through this website.

 

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